Objective. To estimate the excess risk of cardiovascular and cerebrovascular diseases among individuals with ankylosing spondylitis (AS) in Quebec compared with the general population of Quebec.Methods. A retrospective cohort study was conducted using population-based administrative data from Quebec. The cohort included all adult individuals with at least 1 AS diagnosis on physician billing or hospital discharge records between 1996 and 2006. A comparison cohort was generated using a 1% random sample of individuals without AS. Cardiovascular and cerebrovascular diseases, and associated hospitalizations, were classified into 1 of 6 subcategories: congestive heart failure, valvular (aortic or nonaortic) heart disease, ischemic heart disease, cerebrovascular disease, or "other" cardiovascular disease. The age-and sex-stratified prevalence estimates, and standardized prevalence ratios, of cardiovascular or cerebrovascular disease in patients with AS, compared to that in the general population, were calculated.Results. The AS cohort included 8,616 individuals diagnosed over the period 1996-2006. The prevalence of cardiovascular and cerebrovascular diseases increased with increasing age for all cardiovascular disease subgroups, and was similar for individuals of both sexes. Age-and sex-stratified prevalence ratios were highest in younger individuals with AS. The ageand sex-standardized prevalence ratios comparing the risk among those with AS to the risk in the general population were as follows: for aortic valvular heart disease 1.58 (95% confidence interval [95% CI] 1.31-1.91), for nonaortic valvular heart disease 1.58 (95% CI 1.43-1.74), for ischemic heart disease 1.37 (95% CI 1.31-1.44), for congestive heart failure 1.34 (95% CI 1.26-1.42), for "other" cardiovascular disease 1.36 (95% CI 1.29-1.44), for cerebrovascular disease 1.25 (95% CI 1.15-1.35), and for any hospitalization for a cardiovascular or cerebrovascular disease 1.31 (95% CI 1.22-1.41).Conclusion. Compared with the general population, patients with AS are at increased risk for many types of cardiovascular and cerebrovascular diseases, and are more likely to be hospitalized for these diseases. The excess risk is greatest in younger patients with AS.

The estimates are clearly below the most stringent World Health Organization benchmark for cost-effectiveness for Kenya and within the acceptable range of cost-effectiveness for Uganda. Thus, the switch to second-line therapy with LPV/r in these countries appears to be a cost-effective use of resources.

Olanzapine treatment for agitation and psychosis related to Alzheimer's disease is cost effective when compared with no treatment. Further analysis should be performed as atypical antipsychotics become generic, as more information on health utilities in the Alzheimer's disease population becomes available, and to compare atypical antipsychotics with first-generation antipsychotics.

No abstract

OBJECTIVES: Recent advances in treatment for chronic hepatitis C (CHC) virus infection have shortened duration of treatment and increased the likelihood of treatment success. To understand what unmet needs remain with available CHC treatments, patient interviews explored what it is like to live with CHC infection and undergo CHC treatment. A subset of interviews also evaluated the content validity and comprehension of patient-reported outcome (PRO) questionnaires for use in CHC clinical trials. METHODS: Sixty-five patients with clinicianconfirmed diagnosis of CHC infection provided informed consent and completed interviews in Germany (n=15), France (n=15), the USA (n=16), and Canada (n=19). Targeted sampling enrolled a demographically and clinically diverse sample. Concept elicitation (CE) interviews (n=58) using in-depth, open-ended questioning encouraged spontaneous discussion of patients' experience of CHC and its treatment. Patients in the USA and Canada also completed cognitive debriefing (CD) interviews using a 'think aloud' protocol to evaluate content validity and comprehension of the Fatigue Severity Scale (FSS, n=34), Work Productivity and Activity Impairment questionnaire for Hepatitis C (WPAI:Hepatitis C, n=7) and the SKINDEX-16 (n=12). Verbatim transcripts were translated to English and analyzed using thematic analysis. RESULTS: Treatment-related symptoms cause a significant burden for patients during treatment with tiredness (60.0%), sleep problems (57.5%), fatigue (50.0%), depression (45.0%) and itchy skin (40.0%) among the most commonly reported symptoms mentioned in CE interviews. In the 40 patients with CHC treatment experience, treatment-related symptoms led to discontinuation or lack of adherence in 25% and 10%, respectively. CD interviews confirmed that the questionnaires were relevant, understandable and easy to complete. Patients suggested minor wording changes that may make these questionnaires easier to complete. CONCLUSIONS: Treatment-related symptoms cause a significant burden for CHC patients and affect their adherence to treatment. The FSS, WPAI:Hepatitis C, and SKINDEX-16 are valid tools for PRO assessment in CHC clinical trials.